Are there different levels of NHS care funding?

Are there different levels of NHS care funding depending on levels of need?

Tip no. 20 in our series of 27 top tips on NHS Continuing Healthcare…

Here are 3 misstatements of fact families report having been told by some NHS funding assessors about different levels of NHS care funding:

1. “There’s a sliding scale of NHS Continuing Healthcare depending on different combinations of scores given in the assessment process.”

2. “There are high, medium and low levels of funding, depending on your specific care needs.”

3. “CCGs don’t give full funding any more – instead it’s split with the local authority.”

All 3 of these statements are false. Let’s look at each one further:

1. “There’s a sliding scale of NHS Continuing Healthcare depending on different combinations of scores given in the assessment process.” – WRONG

This statement is so wrong, it’s hard to know where to start!

We heard from one family who had been told that each score in the Decision Support Tool (Severe, High, Moderate, Low, etc) was given a number, and those numbers were added up across all the care domains, to reach a numerical total. The amount of money a person would receive was based on that resulting number, i.e. a higher number would result in more money, and a lower number would mean less money.

We hear a lot of horror stories when it comes to NHS Continuing Healthcare, and the amount of misinformation given to families is appalling; this is just one example.

There is no sliding scale. The scores in the Decision Support Tool do not have numbers attached. If a person is eligible for NHS Continuing Healthcare, the CCG must cover the full cost of their care.

2. There are high, medium and low levels of funding, depending on your specific care needs. – WRONG

Again this is not correct.

If you are found eligible for NHS Continuing Healthcare finding, there is one level: the full cost of your care.

If you are found not eligible for NHS Continuing Healthcare, but you are in a nursing home and a Funded Nursing Care (FNC) payment is provided instead, this is one level of payment. Anyone telling you there are different ‘bandings’ of FNC may be thinking about the levels there used to be prior to October 2007. Read more here about Funded Nursing Care payments.

3. CCGs don’t give full funding any more – instead it’s split with the local authority. – WRONG

CCGs are required by law to cover the full cost of care for anyone with a certain level of care needs. Read more about how NHS Continuing Healthcare is assessed.

There is, however, ‘joint funding’, where the NHS pays some of the cost and the local authority does a means test for the rest. Joint funding applies if a person’s health needs are such that they’re ineligible for full NHS Continuing Healthcare care, and yet they do have some nursing care needs.

However, if you’re told that ‘joint funding’ is being recommended, the vital question to ask is why is full NHS Continuing Healthcare not being recommended? There is no blanket rule that says CCGs don’t cover the full cost any more – however much they may try.

Tip no. 19: Disagreement over scores in NHS Continuing Healthcare care domains

Tip no. 21: Start with the highest domain scores in NHS Continuing Healthcare 

You don’t have to fight this battle alone

Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.